Neutralize the reduced fracture with a pre-contoured small fragment pelvic reconstruction plate applied to fit the reduced fracture.
The plate bridges the reduced pelvic brim segment of the anterior column. Cranially, it extends to ensure at least two screws into the intact sciatic buttress. It is positioned in the medial iliac fossa adjacent to the SI joint. The cranial screws are placed anterior to posterior parallel to the SI joint, and typically measure 40-60 mm in length.
Care should be taken to avoid inadvertent violation of the SI joint.
In the mid portion, interfragmentary screws can be applied through the plate. Care should be taken to ensure that each screw is placed extraarticularly, as this region is juxtaarticular.
Inferiorly, the plate can be secured to the pubic ramus and the body of the pubis. Distal fixation becomes increasingly important in lower fractures, in which there are limited superior/cranial fixation opportunities.
In case of osteoporotic bone adequate anchorage of the neutralization plate is only obtained by the use of very long screws near the SI joint and the symphysis pubis. Typically, more screws are required in osteoporotic bone.